Dual benefit of belimumab in post-transplant lupus nephritis: Glucocorticoid withdrawal and extrarenal disease control

IntroductionLupus nephritis (LN), a severe organ impairment associated with systemic lupus erythematosus (SLE), significantly affects patient prognosis. Despite therapeutics advances, up to 15% of patients progress to end-stage kidney disease (ESKD) within 15 years, with kidney transplantation emerging as the preferred renal replacement therapy. Conversely, belimumab has shown promise in enhancing remission rates and improving renal outcomes in LN. however, there is little information in the literature regarding the use of belimumab in kidney transplant patients and its potential interaction with other immunosuppressive therapies.MethodsThis report presents three clinical cases of renal transplant recipients with LN who received belimumab following transplantation to manage their systemic disease The aim of this case report was to evaluate the efficacy and safety of belimumab administration in renal transplant patients.ResultsBelimumab successfully discontinued or reduced the dose of glucocorticoids, resolved the clinical manifestations of SLE and maintained stable renal function throughout follow-up.ConclusionThese cases highlight belimumab's potential as an effective and safe therapeutic option in managing extrarenal SLE symptoms and reducing glucocorticoid dependence in kidney transplant recipients. Although limited data exists, these findings align with previous evidence supporting belimumab's safety and efficacy in LN.